PD-1 Antibody Expressing mesoCAR-T Cells for Mesothelin Positive Advanced Solid Tumor (PAEMCMPAST)

A Clinical Study of PD-1 Antibody Expressing mesoCAR-T Cells for Patients With Mesothelin Positive Advanced Solid Tumors

This is a single-arm, open-label, one center clinical study, to determine the safety and efficacy of infusion of autologous T cells engineered to target mesothelin and express PD-1 antibodies in adult patients with advanced recurrent or refractory malignant solid tumors, which were positive expression of mesothelin.

Study Overview

• Status: Unknown
• Conditions: Advanced Solid Tumor
• Intervention / Treatment: Biological: PD-1 antibody expressing mesoCAR-T cells

Detailed Description

This study will be conducted using a phase I/II trial design to assess the safety and efficacy of the PD-1 antibody expressing mesoCAR-T for patients with mesothelin positive, advanced recurrent or refractory malignant solid tumors. MesoCAR-T can specifically and effectively kill the mesothelin positive cancer cells, PD-1 antibody are secreted from the CAR-T cells could improve immunosuppression microenvironment, new CAR-T cells contain the advantages of CAR-T and immune checkpoint inhibitor, which is a promising therapeutic method for advanced solid tumors.

The new CAR-T therapy is applied to clinical practice as bellow. T cells are prepared from peripheral blood mononuclear cells (PBMC) by leukapheresis, and then activated and engineered to express chimeric antigen receptors (CARs) targeting mesothelin and PD-1 antibody. Cells are proliferated in culture and returned to the patients by venous transfusion therapy. A total of 50 patients may be enrolled in the study. The total duration of the study is expected to be approximately 24 months.

• Study Type: Interventional
• Enrollment (Anticipated): 50
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: Zhiwei Zhang, PhD; Phone Number: 8008 0086-021-59593168; Email: zhangzw@shcell.com

Study Locations

• China
  • Shanghai
    • Shanghai, Shanghai, China, 200072
      • Recruiting
      • China
      • Contact: Xue Yang; Phone Number: 0086-021-66301147; Email: shsyiec@126.com
      • Contact: Juemin Fang; Phone Number: 0086-021-39590256

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Patients with relapsed or refractory advanced solid malignancies (diagnosed by histology or cytology detection), including malignant mesothelioma, pancreatic cancer, bile duct cancer, ovarian cancer, lung cancer, gastric cancer, etc.
2. Patients who failed after second-line treatment, or who are unwilling to receive second-line treatment after failed to recieve first-line treatment.
3. Gender unlimited, age from 18 years to 80 years.
4. Life expectancy ≥ 3 months.
5. Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
6. Adequate venous access for Peripheral blood mononuclear cell (PBMC) apheresis, and no other contraindications.
7. Immunohistochemistry (IHC) score of mesothelin on tumor tissue ≥ 1+.
8. The requirements of laboratory examination: Neutrophilic granulocyte ≥ 1.0×10^9/L; Platelet ≥ 50×10^9/L; Hemoglobin ≥ 90g/L; total bilirubin ≤ 2 times the upper limit of the normal value; Alanine aminotransferase and Aspartate transaminase (ALT and AST) ≤ 2.5 times the upperlimit of the normal value (If there is liver metastasis, they should be ≤ 5 times the upperlimit of the normal value); Serum creatinine ≤ 1.5 times the upper limit of the normalvalue.
9. There is at least one measurable tumor lesion; According to RECIST 1.1 standard, it is suitable to evaluate the therapeutic response and progress of tumor.
10. Patients have adequate ability to understand, sign informed consents and take part in the clinical research voluntarily.
11. Female patients in child bearing period must have evidence of negative pregnancy test or male patients, and they agree to take effective contraceptive measures until 30 days after cells infusion.

Exclusion Criteria:

1. Patients with active viral or bacterial infection, and have failed to be controlled by anti-infective treatment.
2. Patients with seropositive response of Human immunodeficiency virus (HIV) and syphilis, or fail to control the hepatitis B virus or hepatitis C virus infection.
3. Patients who are undergoing treatment of autoimmune or organ transplantation diseases, or patients who need long-term use of immunosuppressive drugs such as glucocorticoid.
4. Patients with severe heart and lung dysfunction, high blood pressure and cannot be controlled with medicine, unstable coronary artery disease (uncontrolled arrhythmias, unstable angina pectoris), uncompensated congestive heart failure, myocardial infarction within six months.
5. Patients with any other illness that the investigators consider it will may affect the patient's treatments, follow-up or assessment, including any uncontrolled clinically significant neurological or psychiatric disorders, immunoregulatory diseases, metabolic diseases, infectious diseases and so on.
6. Received cancer treatment prior to enroll the group within the following time (including drug clinical trials):

(1) The withdrawal time of chemotherapy before enrollment was shorter than the treatment cycle of chemotherapy.

(2) The use of anti-tumor therapy within 4 weeks before the study or less than 5 times of the half-life period of the drugs (including radiation therapy, chemotherapy, small molecules and biological therapy or immunotherapy), the shortest period of time was as the criterion (but the shortest time should not be less than 21 days).

7. Women patients in pregnancy period or suckling period.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: PD-1 antibody expressing mesoCAR-T cells; Patients will receive two cycles of PD-1 antibody expressing mesoCAR-T cells treatment. Every cycle, peripheral blood mononuclear cells (PBMC) are collected on day -18, CAR-T cells are cultured in a GMP standard workshop. Patients are given a three-day regimen of chemotherapy consisting of fludarabine and cyclophosphamide aimed to deplete the lymphocytes before cells infusion. Then the patients will receive an i.v.gtt infusion of PD-1 antibody expressing mesoCAR-T cells from day 1 to day 3 (±3days).

Biological: PD-1 antibody expressing mesoCAR-T cells; Patients with mesothelin positive cancer will be infused the PD-1 antibody expressing mesoCAR-T cells. The modified mesoCAR-T cells can specifically kill mesothelin positive cancer cells and secrete PD-1 antibody, which could enhance the cytotoxicity of mesoCAR-T cells and activate the tumor infiltrating lymphocytes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of treatment-related adverse events of infusion of autologous PD-1 antibody expressing mesothelin-targeted CAR-Tcells	Incidence of treatment-related adverse events are assessed using the NCI CTCAE V4.0 criteria.	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression free survival	Progression free survival is defined as the time from the day in which the patient is enrolled to the date on which tumor progresses or the date on which the patient dies for any cause.	2 years
Overall survival	Overall survival is defined as the time from the day in which the patient is enrolled to the date on which the patient dies for any cause.	2 years
Objective response rate (ORR) of the treatment using PD-1 antibody expressing mesoCAR-T cells for advanced solid tumors	Objective response rate (ORR) of the treatment is assessed according to the response evaluation criteria in solid tumor version 1.1 (RECIST1.1), which contains complete response (CR) and partial response (PR).	2 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proliferation and persistence of mesothelin specific CAR-T cells in peripheral blood of the patients	CAR-T proportionin in peripheral blood of the patients is detected by flow cytometry assay to study the proliferation and persistence of mesothelin specific CAR-T cells.	6 months
PD-1 antibody level in peripheral blood of the patients after treatment	PD-1 antibody level are detected by ELISA assay to assess the expressing level of PD-1 antibody from CAR-T cells.	6 months

Collaborators and Investigators

• Sponsor: Shanghai Cell Therapy Research Institute
• Investigators: Study Chair: Qijun Qian, PhD, Shanghai Cell Therapy Research Institute; Study Chair: Huajun Jin, PhD, Shanghai Cell Therapy Research Institute; Principal Investigator: Qing Xu, PhD, Shanghai 10th People's Hospital; Study Director: Zhiwei Zhang, PhD, Shanghai Cell Therapy Research Institute; Study Director: Huimei Li, PhD, Shanghai Cell Therapy Research Institute; Principal Investigator: Juemin Fang, PhD, Shanghai 10th People's Hospital; Principal Investigator: Song Gao, PhD, Shanghai 10th People's Hospital; Principal Investigator: Xianling Guo, Shanghai 10th People's Hospital; Principal Investigator: Hui Wang, Shanghai 10th People's Hospital; Principal Investigator: Zhongzheng Zhu, Shanghai 10th People's Hospital; Principal Investigator: Jianhua Chen, Shanghai 10th People's Hospital

Publications and helpful links

General Publications

• Fang J, Ding N, Guo X, Sun Y, Zhang Z, Xie B, Li Z, Wang H, Mao W, Lin Z, Qin F, Yuan M, Chu W, Qin H, Qian Q, Xu Q. alphaPD-1-mesoCAR-T cells partially inhibit the growth of advanced/refractory ovarian cancer in a patient along with daily apatinib. J Immunother Cancer. 2021 Feb;9(2):e001162. doi: 10.1136/jitc-2020-001162.

Study record dates

Study Major Dates

• Study Start (ANTICIPATED): August 6, 2018
• Primary Completion (ANTICIPATED): August 3, 2020
• Study Completion (ANTICIPATED): December 3, 2020

Study Registration Dates

• First Submitted: June 28, 2018
• First Submitted That Met QC Criteria: July 30, 2018
• First Posted (ACTUAL): August 3, 2018

Study Record Updates

• Last Update Posted (ACTUAL): August 3, 2018
• Last Update Submitted That Met QC Criteria: July 30, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Keywords: mesothelin, PD-1, CAR T cells, solid tumor
• Additional Relevant MeSH Terms: Neoplasms; Physiological Effects of Drugs; Immunologic Factors; Antibodies
• Other Study ID Numbers: SHSY-IEC-4.0/18-09/02

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No